Psychotherapy is Hard Work...Why Bother?

by Patricia Thornton

Patricia Thornton, PhD specializes in the treatment of anxiety disorders and OCD. She practices in New York City.

In my first meeting with new patients who struggle with OCD and anxiety, I explain that the type of psychotherapy I practice, Exposure and Response Prevention, involves encouraging them to feel uncomfortable. It’s a type of therapy that they will not particularly “enjoy,” but it’s a therapy that will hopefully get them back to enjoying their lives.

When I lay down the groundwork for our work together, I tell my patients, “My goal is for you to not need me…as soon as possible. I’ll help you to have new experiences that are likely to change the way your brain works. And then I’m getting out of your way so you can experience life from a different vantage point. But it’s going to require really hard work.”

My patients sometimes plead with me to make the hard work of this type of psychotherapy easier. After I’ve challenged them to expose themselves to something they’re fearful of I’ll hear, “You know this is really, really hard!” And I answer, “Yes, I know. This work is really, really hard! It’s difficult because you are rewiring your brain to tolerate uncertainty, anxiety, yucky feelings, and intrusive disturbing thoughts. You are going to feel really uncomfortable. Remind yourself why you want to do this hard work.”

How do I encourage my patients to try this therapy and to stick with it? At the outset of therapy I ask them what they have lost by struggling with anxiety or OCD. I ask what they’ve done in the past to ease their symptoms and how successful that was for them. And I ask them to envision what their life would be like once their symptoms are no longer controlling them. What would they be able to do that they are not doing now? I ask them to write these goals down and to keep these in mind, and in hand, as they do the work. For OCD sufferers and those struggling with any type of anxiety disorder, there is an overwhelming pull, dictated by anxiety, to keep doing maladaptive behaviors in order to avoid being uncomfortable. If a patient has the drive and vision to have a freer life and a belief that it can be achieved, then they are more willing to allow themselves to be uncomfortable and engage in the hard work of psychotherapy.

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ADAA is an international nonprofit organization dedicated to the prevention, treatment, and cure of anxiety, depressive, obsessive-compulsive, and trauma-related disorders through education, practice, and research.